Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This policy brief provides information on prevalence of children's mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs.